Omnicare Inc., False Claims Act Violations, Sacramento CA, 2023

SACRAMENTO, Calif. — Omnicare Inc., a national long-term care pharmacy, has settled a lawsuit with federal and state authorities for $2.24 million over allegations of improper billing to federal and state health care programs.

Specifically, the settlement resolves accusations that Omnicare employees manually altered the National Drug Code (NDC) on claims resubmitted to Medicare, Medicaid, and TRICARE to bypass prior payment rejections. The fraudulent activity is alleged to have taken place between January 1, 2006, and September 1, 2014, predating the acquisition of Omnicare by CVS Health Corporation.

As part of the settlement, CVS Health Corporation and its subsidiaries also entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). The CIA is aimed at enhancing accountability and transparency within their institutional pharmacy services operations to prevent future fraud and abuse.

Acting U.S. Attorney Talbert emphasized, “We are committed to ensuring the integrity of the federal health care system, and this extends to paying only for drugs that accurately reflect an underlying prescription.”

The lawsuit was initially brought under the qui tam provisions of the False Claims Act by a former Regional Service Area Director at Omnicare’s Lodi, California pharmacy. Under the Act, private citizens with knowledge of false claims can bring civil actions on behalf of the government and share in recoveries, with the whistleblower set to receive approximately $411,624 from the settlement proceeds.

This case was a collaborative effort led by Assistant United States Attorney Edward Baker and involved the Department of Health and Human Services Office of Inspector General, Office of General Counsel, the Civil Division of the Department of Justice, the Federal Bureau of Investigation, and the Defense Health Agency. A team from the National Association of Medicaid Fraud Control Units also contributed to the investigation and settlement negotiations on behalf of the states, including California, Massachusetts, New York, Ohio, and Texas.

The claims settled are allegations only; no determination of liability has been made.